Trans-inclusive HIV services are needed in the Philippines’ post-pandemic recovery
Authors: Rowalt Alibudbud
Journal: The Lancet Global Health (2023)

Before the COVID-19 pandemic, HIV in the Philippines was the fastest-growing epidemic in WHO Western Pacific region.1Alibudbud R The Philippine HIV crisis and the COVID-19 pandemic: a worsening crisis.Public Health. 2021; 200: e1Crossref PubMed Scopus (3) Google Scholar, 2Alibudbud RC The triple stigma of HIV and chemsex among gays, bisexuals, and other men who have sex with men (GBMSM) in the Philippines.Asian Pac J Trop Med. 2022; 15: 477-478Crossref Scopus (1) Google Scholar Although HIV infections remain concentrated among men, HIV infections reported among transgender women doubled during the COVID-19 pandemic. The total HIV infections among this population increased from 714 in 2019 to 1560 in 2022, representing an 118% increase during the pandemic (appendix).3Department of HealthHIV/AIDS and ART registry of the Philippines December 2022.https://doh.gov.ph/sites/default/files/statistics/EB_HARP_December_AIDSreg2022.pdfDate: 2022Date accessed: March 18, 2023Google Scholar Transgender women aged 25 to 34 were most affected, accounting for 50% of the total HIV infections, followed by those aged 15–24 years, who account for 28%.3Department of HealthHIV/AIDS and ART registry of the Philippines December 2022.https://doh.gov.ph/sites/default/files/statistics/EB_HARP_December_AIDSreg2022.pdfDate: 2022Date accessed: March 18, 2023Google Scholar The most common mode of HIV transmission among transgender women was sexual contact, which accounts for 99% of all reported infections.3Department of HealthHIV/AIDS and ART registry of the Philippines December 2022.https://doh.gov.ph/sites/default/files/statistics/EB_HARP_December_AIDSreg2022.pdfDate: 2022Date accessed: March 18, 2023Google Scholar Therefore, as the Philippines pursue equitable health, trans-inclusive HIV services should be prioritised while the country recovers from the pandemic. Transgender women experience both the stigma of HIV and of their identity as a minoritised gender in the Philippines.2Alibudbud RC The triple stigma of HIV and chemsex among gays, bisexuals, and other men who have sex with men (GBMSM) in the Philippines.Asian Pac J Trop Med. 2022; 15: 477-478Crossref Scopus (1) Google Scholar, 4Abesamis LEA Intersectionality and the invisibility of transgender health in the Philippines.Glob Health Res Policy. 2022; 7: 35Crossref PubMed Scopus (0) Google Scholar With stigma remaining a barrier to help-seeking behavior for HIV,2Alibudbud RC The triple stigma of HIV and chemsex among gays, bisexuals, and other men who have sex with men (GBMSM) in the Philippines.Asian Pac J Trop Med. 2022; 15: 477-478Crossref Scopus (1) Google Scholar programmes that promote and normalise HIV and transgender equality should be strengthened. For example, the Philippine Government can incorporate HIV awareness and transgender equality into the current basic and community health-education framework. The government and non-governmental organisations need to improve the accessibility of HIV care, including prevention services and pre-exposure prophylaxis.1Alibudbud R The Philippine HIV crisis and the COVID-19 pandemic: a worsening crisis.Public Health. 2021; 200: e1Crossref PubMed Scopus (3) Google Scholar, 2Alibudbud RC The triple stigma of HIV and chemsex among gays, bisexuals, and other men who have sex with men (GBMSM) in the Philippines.Asian Pac J Trop Med. 2022; 15: 477-478Crossref Scopus (1) Google Scholar For instance, in 2017 UNAIDS noted that only 27% of transgender people were covered by HIV care programmes in the country.5Restar AJ Chan RCH Adia A et al.Prioritizing HIV services for transgender women and men who have sex with men in Manila, Philippines: an opportunity for HIV provider interventions.J Assoc Nurses AIDS Care. 2020; 31: 405-416Crossref PubMed Scopus (4) Google Scholar Since most HIV services are available in urban areas,1Alibudbud R The Philippine HIV crisis and the COVID-19 pandemic: a worsening crisis.Public Health. 2021; 200: e1Crossref PubMed Scopus (3) Google Scholar primary and rural health-care workers should be trained to provide HIV care in their localities. Health-care providers might have hesitancies in providing health care services to transgender women because of their lack of knowledge and training on the health-care needs of transgender people.4Abesamis LEA Intersectionality and the invisibility of transgender health in the Philippines.Glob Health Res Policy. 2022; 7: 35Crossref PubMed Scopus (0) Google Scholar, 5Restar AJ Chan RCH Adia A et al.Prioritizing HIV services for transgender women and men who have sex with men in Manila, Philippines: an opportunity for HIV provider interventions.J Assoc Nurses AIDS Care. 2020; 31: 405-416Crossref PubMed Scopus (4) Google Scholar Therefore, the Government and service providers with gender-affirming health-care competencies, such as LoveYourself,4Abesamis LEA Intersectionality and the invisibility of transgender health in the Philippines.Glob Health Res Policy. 2022; 7: 35Crossref PubMed Scopus (0) Google Scholar can collaborate to offer continuing professional development units to HIV specialist clinics and primary care providers. Ensuring that future health professionals are competent in trans-inclusive health care is essential to sustain trans-inclusive health services, research, and education in the Philippines. Currently, the country's health and medical education does not sufficiently cover the health-care needs of transgender people,4Abesamis LEA Intersectionality and the invisibility of transgender health in the Philippines.Glob Health Res Policy. 2022; 7: 35Crossref PubMed Scopus (0) Google Scholar making its incorporation into the curriculum necessary. For example, medical classes, such as internal medicine and psychiatry, can include the discussion of transgender-relevant information, such as gender-affirming therapies and gender dysphoria. Overall, trans-inclusive HIV services are needed to address the growing HIV infections among transgender women in the Philippines. I declare no competing interests. Download .pdf (.12 MB) Help with pdf files Supplementary appendix